Page 141 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Introduction
Primary malignant bone tumors commonly grow in close proximity to joints1, 2. Resection with clear margins is the mainstay of surgical treatment and therefore, it is often necessary to resect part of a joint3, 4. Endoprostheses are generally regarded as the benchmark after such resections5, 6. However, endoprosthetic joint arthroplasty requires the sacri ce of the corresponding reciprocal side of the joint. Moreover, recent studies describe considerable rates of failure of endoprosthetic reconstruction due to both mechanical (loosening, implant breakage, periprosthetic fractures) and non-mechanical (predominantly infection) complications6-8.
Osteoarticular allografts provide an alternative method of reconstruction
to endoprostheses. Potential advantages of osteoarticular allografts include the
possibility to re-attach tendons and to reconstruct unicondylar or hemi-articular
defects9, 10. On the other hand, allografts have been associated with considerable
rates of infection, fracture and nonunion3, 11-14. Reported overall complication rates
typically range from 40% to 70%9, 15-25. Moreover, studies raised concern about the
viability of cryopreserved cartilage and noted that osteoarthritis becomes a major 7 problem approximately six years after transplantation26, 27. Nevertheless, functional
outcome is generally acceptable, with mean Musculoskeletal Tumor Society
(MSTS) scoring system scores28 ranging from 70% to 91%9, 16-18, 23-25, 29, 30.
To date, there are no studies on large groups of patients with osteoarticular allografts with long-term follow-up. Therefore, there is paucity of solid evidence concerning complications and long-term outcomes. We retrospectively evaluated our experiences with osteoarticular allografts in treatment of primary tumors and systematically reviewed the literature with the aims to assess: long-term complication rates, mechanisms of reconstruction failure, and allograft survival rates.
Patients and Methods
Retrospective study
We searched our institutional database to identify all patients who had an osteoarticular allograft reconstruction for a bone tumor between 1989 and 2012. A total of 38 consecutive patients (28 men, 74%) with a median age of 19 years
Osteoarticular allografts
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